Compassion: a scoping review of the healthcare literature

The impact of compassion-based interventions on perioperative anxiety and depression: A systematic review and meta-analysis

BACKGROUND

The perioperative period can be a stressful time for many patients. Concerns for the procedure or fearing potential complications contribute to perioperative anxiety and depression, which significantly impact patient wellbeing and recovery. Understanding the psychological impact of the perioperative period can inform individualized care focused on each patient's unique stressors. Compassion-based interventions are limited but have shown benefits in non-surgical healthcare settings, and can provide support by prioritizing empathy and understanding in the perioperative period. This review evaluates the impact of compassion-based interventions on anxiety and depression among adult surgical patients.

METHODS

A systematic review of 25 randomized controlled trials was conducted with a meta-analysis of 14 studies for anxiety and 9 studies for depression that provided sufficient information.

RESULTS

The included studies tested compassion-based interventions that focused on enhanced communication, emotional support, and individualized attention from healthcare professionals. In 72 % of the studies, the interventions decreased anxiety and depression, compared to control groups. These interventions improved health-related outcomes such patient satisfaction and postoperative complications. The meta-analysis indicated a large effect of the compassion-based interventions for anxiety (g = -0.95) and depressive symptoms (g = -0.82). The findings were consistent among various surgeries and patient populations.

LIMITATIONS

Many of the included studies lacked clarity in their methods and only 14 studies provided sufficient information for the meta-analysis.

CONCLUSIONS

Given the growing evidence suggesting that compassion-based psychological interventions are feasible and applicable in the perioperative setting, their inclusion in routine care could reduce depression and anxiety around surgery and improve patient outcomes and experiences.

Compassionate nursing in challenging contexts: The importance of judgments

BACKGROUND

Nurses' demonstration of compassion is an ethical and often regulatory expectation. While research has been conducted to examine the barriers and facilitators of compassion in nurses, little is known about how nurses develop and express compassion for patients who may be blamed for their health condition. Unvaccinated COVID-19 patients are an example of such patients.

RESEARCH QUESTIONS

How do nurses provide compassionate care for unvaccinated adults infected with COVID-19? How did the context of COVID-19 vaccination in Canada shape nurses' relationships with unvaccinated patients?

RESEARCH DESIGN

A generic qualitative approach using interviews to gather data was used. Martha Nussbaum's conceptualization of compassion and its cognitive requirements was employed to add depth to the analysis.

PARTICIPANTS AND RESEARCH CONTEXT

Seventeen Registered Nurses, from a range of practice settings, who had cared for unvaccinated patients with COVID-19 participated.

ETHICAL CONSIDERATIONS

Ethics approval was received, and signed informed consent was obtained. Participants who were the current students of the researchers were excluded.

FINDINGS

Three themes were identified:1) Encountering Extreme Workplace Impediments to Compassion.2) Managing Emotions to Provide "Nonjudgmental Care."3) Practicing Narrative Imagination.

DISCUSSION

The difficult working conditions during the pandemic impeded nurses' capacity to be compassionate. Yet, none judged their patients' suffering as trivial, and all provided necessary nursing care. Some initially blamed these patients for the severity of their illness and suppressed their emotions to provide what they called "nonjudgmental care." Upon reflection, participants recognized that these patients' life circumstances may have been barriers to vaccination which, in the end, facilitated the development of compassion.

CONCLUSION

This research has implications that go beyond that of caring for patients with COVID-19. The ideal of "nonjudgmental care" requires critical re-examination because judgments and emotions are required for compassion.

Compassion, stress and coping strategies in family caregivers of patients with heart failure

The requirements of caring for individuals with diseases with excess care burden like heart failure (HF) comprise a source of stress for the caregiver. This situation affects the health of caregivers and may cause a reduction in their level of compassion. However, compassion is associated with psychological benefits and coping strategies like positive mood in caregivers. The aim of this study was to investigate the correlations between compassion, coping strategies and stress levels of family members caring for individuals with HF. We found that the dysfunctional coping strategies were determined to play a partial mediating role in the relationship between caregiver compassion levels and stress levels. Caregivers with higher compassion levels reported lower stress levels. This situation may be linked to their use of relatively fewer dysfunctional coping strategies. Findings help to examine the correlations between compassion, coping strategies and stress levels of family members caring for individuals with HF.

Patient and Provider Experiences With Compassionate Care in Virtual Physiatry: Qualitative Study

BACKGROUND

Telemedicine in the realm of rehabilitation includes the remote delivery of rehabilitation services using communication technologies (eg, telephone, emails, and video). The widespread application of virtual care grants a suitable time to explore the intersection of compassion and telemedicine, especially due to the impact of COVID-19 and how it greatly influenced the delivery of health care universally.

OBJECTIVE

The purpose of this study was to explore how compassionate care is understood and experienced by physiatrists and patients engaged in telemedicine.

METHODS

We used a qualitative descriptive approach to conduct interviews with patients and physiatrists between June 2021 and March 2022. Patients were recruited across Canada from social media and from a single hospital network in Toronto, Ontario. Physiatrists were recruited across Canada through social media and the Canadian Association for Physical Medicine and Rehabilitation (CAPM&R) email listserve. Interviews were recorded and transcribed. Data were analyzed thematically.

RESULTS

A total of 19 participants were interviewed-8 physiatrists and 11 patients. Two themes capturing physiatrists' and patients' experiences with delivering and receiving compassionate care, especially in the context of virtual care were identified: (1) compassionate care is inherently rooted in health care providers' inner intentions and are, therefore, expressed as caring behaviors and (2) virtual elements impact the delivery and receipt of compassionate care.

CONCLUSIONS

Compassionate care stemmed from physiatrists' caring attitudes which then manifest as caring behaviors. In turn, these caring attitudes and behaviors enable individualized care and the establishment of a safe space for patients. Moreover, the virtual care modality both positively and negatively influenced how compassion is enacted by physiatrists and received by patients. Notably, there was large ambiguity around the norms and etiquette surrounding virtual care. Nonetheless, the flexibility and person-centeredness of virtual care cause it to be useful in health care settings.

What role does compassion have on quality care ratings? A regression analysis and validation of the SCQ in emergency department patients

OBJECTIVE

To examine the unique contribution of patient reported experiences of compassion to overall patient quality care ratings. Additionally, we assess whether patients' reported experiences of compassion in the emergency department differed between sociodemographic groups.

METHODS

Provincial data for this cross-sectional study were collected from 03/01/2022 to 09/05/2022 from 14 emergency departments in Alberta, Canada. Data from 4501 emergency department patients (53.6% women, 77.1% White/European) were analyzed. The primary outcome was patients' overall quality care ratings during their most recent ED visit. Measures included in the hierarchical stepwise regression included demographics, and those drawn from the Emergency Department Patient Experience of Care (EDPEC) questionnaire: single and multi-item measures of patient information (e.g., patient perceptions health) and patient experience (e.g., physician communication), and compassion (e.g., Sinclair Compassion Questionnaire; SCQ-ED).

RESULTS

Data from 4501 ED patients were analysed. Stepwise hierarchical linear multiple regression indicated that of 21 included variables, compassion most strongly predicted overall quality care ratings (b=1.61, 95% CI 1.53-1.69, p<.001, f2=.23), explaining 19% unique variance beyond all other measures. One-way ANOVAs indicated significant demographic differences in mean compassion scores, such that women (vs. men) reported lower compassion (MD=-.15, 95% CI=-.21, -.09, p<.001), and Indigenous (vs. White) patients reported lower compassion (MD=-.17, 95% CI =-.34, -.01, p=.03).

CONCLUSIONS

Compassion was identified as a key contributor to ED overall quality care ratings, and experiences of compassion varied as a function of demographics. Patient-reported compassion is an indicator of quality care that needs to be formally integrated into clinical care and quality care assessments.

Compassionate care through the eyes of patients and physicians: An interview study

BACKGROUND

Although compassion is a crucial element of physicians' professional performance and high-quality care, research shows it often remains an unmet need of patients. Understanding patients' and physicians' perspectives on compassionate care may provide insights that can be used to foster physicians' ability to respond to patients' compassion needs. Therefore, this study aims to understand how both patients and physicians experience the concept and practice of compassionate care.

METHODS

We conducted semi-structured interviews with eight patients and ten resident physicians at a University Medical Center in the Netherlands. Using thematic analysis, we separately coded patient and resident transcripts to identify themes capturing their experiences of compassionate care. This study was part of a larger project to develop an educational intervention to improve compassion in residents.

RESULTS

For both patients and residents, we identified four themes encompassing compassionate care: being there, empathizing, actions to relieve patients' suffering, and connection. For residents, a fifth theme was professional fulfillment (resulting from compassionate care). Although patients and residents both emphasized the importance of compassionate care, patients did not always perceive the physician-patient encounter as compassionate. According to residents, high workloads and time pressures hindered their ability to provide compassionate care.

DISCUSSION AND CONCLUSION

Patients and residents have similar and varying understandings of compassionate care at the same time. Understanding these differences can aid compassion in medical practice. Based on the findings, three topics are suggested to improve compassion in residents: (1) train residents how to ask for patients' compassion needs, (2) address residents' limiting beliefs about the concept and practice of compassion, and (3) acknowledge the art and science of medicine cannot be separated.

The Mediating Effect of Professional Values on the Relationship Between Self-Leadership and Compassion Competence of Community Mental Health Nurses

BACKGROUND

Compassion competence is a core nursing skill that is significant in understanding and alleviating the physical and mental distress of individuals. Self-leadership and nursing professional values are also reported as important factors in improving the clinical care practices of nurses and may have a positive effect on improving the compassion competence of nurses. However, there are few studies examining the relationship between these variables in community mental health nurses.

AIM

This study investigated the mediating effect of professional values on the relationship between self-leadership and compassion competence of community mental health nurses.

METHODS

A cross-sectional correlational study was conducted with 121 community mental health nurses from 30 mental health welfare centers in South Korea. Participants completed self-report scales on self-leadership, nursing professional values, and compassion competence. Baron and Kenny's regression method and the Sobel test revealed significant mediating effects of nursing professional values on the relationship between self-leadership and compassion competence.

FINDINGS

Participants' mean compassion competence scores were 3.57 (SD = 0.45) on a 5-point scale. Compassion competence positively correlated with self-leadership (r = 0.67, P < .001) and nursing professional values (r = 0.60, P < .001). Nursing professional values played a partial mediating role in the relationship between self-leadership and compassion competence (Z = 3.23, P = .001).

CONCLUSION

Compassion competence of community mental health nurses can be improved by promoting self-leadership and nursing professional values.

The initial validation of an Evidence-informed, competency-based, Applied Compassion Training (EnACT) program: a multimethod study

INTRODUCTION

Compassion is positively associated with improved patient outcomes, quality care ratings, and healthcare provider wellbeing. Supporting and cultivating healthcare providers' compassion through robust and meaningful educational initiatives has been impeded by a lack of conceptual clarity, inadequate content coverage across the domains of compassion, and the lack of validated evaluation tools. The EnACT program aims to address these gaps through an Evidence-informed, competency-based, Applied, Compassion Training program delivered to healthcare providers working in various clinical settings. In this study, we describe the development and initial validation of the program, which will inform and be further evaluated in a forthcoming Randomised Controlled feasibility Trial (RCfT).

METHOD

A multimethod design was used to explore learner needs, experiences, and outcomes associated with the program. Pre- and post-training surveys and qualitative interviews (1 month post training) were conducted among twenty-six healthcare provider learners working in acute care and hospice. Quantitative measures assessed professional fulfillment/burnout, self-confidence in providing compassion, learner satisfaction, and compassion competence. Qualitative interviews explored learners' experiences of the program, integration of learnings into their professional practice, and program recommendations.

RESULTS

Learners exhibited relatively high self-assessed compassion competence and professional fulfillment pre-training and low levels of burnout. Post-training, learners demonstrated high levels of compassion confidence and satisfaction with the training program. Despite high levels of reported compassion competence pre-training, a statistically significant increase in post-training compassion competence was noted. Thematic analysis identified five key themes associated with learners' overall experience of the training day and integration of the learnings and resources into their professional practice: (1) A beginner's mind: Learner baseline attitudes and assumptions about the necessity and feasibility of compassion training; (2) Learners' experiences of the training program; (3) Learner outcomes: integrating theory into practice; (4) Creating cultures of compassion; and (5) Learner feedback.

CONCLUSION

Findings suggest that the EnACT program is a feasible, rigorous, and effective training program for enhancing healthcare provider compassion. Its evidence-based, patient-informed, clinically relevant content; interactive in class exercises; learner toolkit; along with its contextualized approach aimed at improving the clinical culture learners practice holds promise for sustaining learnings and clinical impact over time-which will be further evaluated in a Randomized Controlled feasibility Trial (RCfT).

Kindness in healthcare leadership and management: an evaluation and analysis of the concept

BACKGROUND

Healthcare leadership and management impacts every patient journey and every staff experience. Good leadership results in positive outcomes. Kindness is an understudied and underused leadership strategy. The research questions addressed in this study are the following: (1) Does kindness in healthcare leadership and management currently meet the criteria of a mature concept?; (2) Using concept analysis methodology, can we develop our understanding of kindness within this context?

METHODS

A systematic search of the peer-reviewed literature was conducted to inform a concept evaluation, followed by a concept analysis. Search terms consisted of 'leader*' or 'manage*' and 'kindness'; databases searched comprised MEDLINE, HMIC, SPP, APA PsycInfo and CINAHL. Data extraction and thematic analysis of the data were performed manually according to concept analysis principles.

RESULTS

The 10 papers included from the search suggested that within healthcare leadership and management, kindness is an 'emerging' rather than a 'mature' concept. Concept analysis demonstrated a cluster of recurring attributes, allowing a theoretical definition to be put forth.

CONCLUSIONS

Despite being a commonly used lay term, kindness in the context of healthcare leadership and management is not yet a mature concept. Work developing this concept is needed to validate the proposed theoretical definition. Observational studies and systematic review of the grey literature are recommended.

Conceptualization, use, and outcomes associated with compassion in the care of youth with childhood-onset disabilities: a scoping review

Introduction

To examine the scope of existing literature on the conceptualization, use, and outcomes associated with compassion in the care of youth with childhood-onset disabilities.

Methods

A protocol was developed based on the Joanna Briggs Institute (JBI) scoping review method. MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and EBSCOhost CINAHL, were searched.

Results

Eight studies were selected for inclusion; four used quantitative methodology, and four used qualitative methods. Compassion was not defined a priori or a posteriori in any of the included studies. The concept of self-compassion was explicitly defined only for parents of youth with childhood-onset disabilities in three studies a priori. The most reported outcome measure was self-compassion in parents of youth with childhood-onset disabilities. Self-compassion among parents was associated with greater quality of life and resiliency and lower stress, depression, shame and guilt.

Discussion

There is limited evidence on the conceptualization, use, and outcomes associated with compassion among youth with childhood-onset disabilities. Self-compassion may be an effective internal coping process among parents of youth with childhood-onset disabilities. Further research is required to understand the meaning of compassion to youth with childhood-onset disabilities, their parents and caregivers.

Systematic review registration

https://doi.org/10.17605/OSF.IO/2GRB4.

Evaluating the Effectiveness of Empathy-Based Education in Undergraduate Nursing: A Scoping Review

BACKGROUND

Empathy is an essential trait in nursing practice that improves the quality of patient care. Nursing curricula that incorporate empathy-based experiential learning (i.e., hands-on educational experiences and reflections designed to foster and develop emotional intelligence) promote students' self-awareness and confidence when providing care to patients. This scoping review examined studies that explored the effects of educational interventions on the development of empathy in undergraduate nursing students.

METHOD

Searches were conducted in MEDLINE using keywords related to nursing education and translated into CINAHL, EMBASE, and ERIC databases.

RESULTS

A total of 6,238 studies were identified. After duplicate and unrelated articles were excluded, 18 publications were considered for this review. Sixteen studies concluded empathy interventions were effective, five indicated the need for further research, and two implicated a need for standardization in empathy-evaluation tools.

CONCLUSION

This review endorses the effectiveness of educational interventions and supports their implementation to promote empathy in undergraduate nursing students. [J Nurs Educ. 2024;63(6):367-371.].

Adaptive Mentoring Networks and Compassionate Care: A Qualitative Exploration of Mentorship for Chronic Pain, Substance Use Disorders and Mental Health

This study undertook an exploration of how Adaptive Mentoring Networks focusing on chronic pain, substance use disorders and mental health were supporting primary care providers to engage in compassionate care. The study utilised the Cole-King & Gilbert Compassionate Care Framework to guide qualitative semi-structured interviews of participants in two Adaptive Mentoring Networks in Ontario, Canada. Fourteen physician participants were interviewed including five mentors (psychiatrists) and nine mentees (family physicians) in the Networks. The Cole-King & Gilbert Framework helped provide specific insights on how these mentoring networks were affecting the attributes of compassion such as motivation, distress-tolerance, non-judgement, empathy, sympathy, and sensitivity. The findings of this study focused on the role of compassionate provider communities and the development of skills and attitudes related to compassion that were both being supported in these networks. Adaptive Mentoring Networks can support primary care providers to offer compassionate care to patients with chronic pain, substance use disorders, and mental health challenges. This study also highlights how these networks had an impact on provider resiliency, and compassion fatigue. There is promising evidence these networks can support the "quadruple aim" for healthcare systems (improve patient and provider experience, health of populations and value for money) and play a role in addressing the healthcare provider burnout and associated health workforce crisis.

Exploring the impact of compassion and leadership on patient safety and quality in healthcare systems: a narrative review

BACKGROUND

Patient safety and healthcare quality are considered integral parts of the healthcare system that are driven by a dynamic combination of human and non-human factors. This review article provides an insight into the two major human factors that impact patient safety and quality including compassion and leadership. It also discusses how compassion is different from empathy and explores the impact of both compassion and leadership on patient safety and healthcare quality. In addition, this review also provides strategies for the improvement of patient safety and healthcare quality through compassion and effective leadership.

METHODS

This narrative review explores the existing literature on compassion and leadership and their combined impact on patient safety and healthcare quality. The literature for this purpose was gathered from published research articles, reports, recommendations and guidelines.

RESULTS

The findings from the literature suggest that both compassion and transformational leadership can create a positive culture where healthcare professionals (HCPs) prioritise patient safety and quality. Leaders who exhibit compassion are more likely to inspire their teams to deliver patient-centred care and focus on error prevention.

CONCLUSION

Compassion can become an antidote for the burnout of HCPs. Compassion is a behaviour that is not only inherited but can also be learnt. Both compassionate care and transformational leadership improve organisational culture, patient experience, patient engagement, outcomes and overall healthcare excellence. We propose that transformational leadership that reinforces compassion remarkably improves patient safety, patient engagement and quality.

The relationship between moral courage and lovingkindness-compassion levels in critical care nurses: A cross-sectional study

BACKGROUND

Ethical dilemmas and ethical problems are very common in intensive care units. Nurses need moral courage to deal with these problems. Nurses' high empathy, humility, lovingkindness, and compassion support them to act with moral courage.

OBJECTIVES

The aim of this study was to determine the moral courage, lovingkindness, and compassion levels of critical care nurses and to reveal whether there is a relationship between them.

METHODS

One hundred sixty-eight nurses working in the intensive care unit of a university hospital in Turkey were included in this correlational descriptive cross-sectional study. The data were collected with the Nurses' Moral Courage Scale (NMCS) and the Loving-kindness Compassion Scale (LCS).

RESULTS

There was a positive and significant relationship between the NMCS and the LCS lovingkindness (r = .377, p < .05) and compassion (r = .405, p < .05) subdimensions; on the other hand, a negative and significant relationship was observed with the LCS self-centredness subdimension (r = -.215, p = .025). In addition, the mean scores of the LCS subdimensions of compassion, self-centredness, and lovingkindness were predictors of the NMCS total score (R = .475, R2 = .286, p < .05).

CONCLUSIONS

In this study, it was determined that critical care nurses with high moral courage levels had high levels of compassion and lovingkindness and low levels of self-centredness. A high level of moral courage and compassion in nurses may contribute to quality and safe patient care. In-service trainings may be planned to increase nurses' awareness of moral courage, loving-kindness, and compassion.

Caring to care: Nurturing ICU healthcare professionals' wellbeing for enhanced patient safety

Healthcare professionals working in the Intensive Care Unit (ICU) care for patients suffering from a critical illness and their relatives. Working within a team of people with different personalities, competencies, and specialties, with constraints and demands might contribute to a working environment that is prone to conflicts and disagreements. This highlights that the ICU is a stressful place that can threaten healthcare professionals' wellbeing. This article aims to address the concept of wellbeing by describing how the stressful ICU work-environment threatens the wellbeing of health professionals and discussing how this situation jeopardizes patient safety. To promote wellbeing, it is imperative to explore actionable interventions such as improve communication skills, educational sessions on stress management, or mindfulness. Promoting ICU healthcare professionals' wellbeing through evidence-based strategies will not only increase their personal resilience but might contribute to a safer and more efficient patient care.

Top Ten Tips Palliative Care Clinicians Should Know About Dignity-Conserving Practice

The acknowledgment and promotion of dignity is commonly viewed as the cornerstone of person-centered care. Although the preservation of dignity is often highlighted as a key tenet of palliative care provision, the concept of dignity and its implications for practice remain nebulous to many clinicians. Dignity in care encompasses a series of theories describing different forms of dignity, the factors that impact them, and strategies to encourage dignity-conserving care. Different modalities and validated instruments of dignity in care have been shown to lessen existential distress at the end of life and promote patient-clinician understanding. It is essential that palliative care clinicians be aware of the impacts of dignity-related distress, how it manifests, and common solutions that can easily be adapted, applied, and integrated into practice settings. Dignity-based constructs can be learned as a component of postgraduate or continuing education. Implemented as a routine component of palliative care, they can provide a means of enhancing patient-clinician relationships, reducing bias, and reinforcing patient agency across the span of serious illness. Palliative care clinicians-often engaging patients, families, and communities in times of serious illness and end of life-wield significant influence on whether dignity is intentionally integrated into the experience of health care delivery. Thus, dignity can be a tangible, actionable, and measurable palliative care goal and outcome. This article, written by a team of palliative care specialists and dignity researchers, offers 10 tips to facilitate the implementation of dignity-centered care in serious illness.

Cultivating compassion in medicine: a toolkit for medical students to improve self-kindness and enhance clinical care

BACKGROUND

Compassionate care lies at the foundation of good patient care and is a quality that patients and providers continue to value in the fast-paced setting of contemporary medicine. Compassion is often discussed superficially in medical school curricula, but the practical aspect of learning this skill is often not taught using a formal framework. In the present work, the authors present an 8-session curriculum with a mindfulness-based approach to compassion that addresses this need. It is hypothesized that students in this curriculum will improve in their levels of compassion based on validated scales.

METHODS

The curriculum was delivered to fourth-year medical students at Renaissance School of Medicine at Stony Brook University who had just completed their clerkship year. It was developed as a customizable set of modules that could be delivered in various ways. The students were taught with evidence-based cognitive exercises followed by group discussions and written reflections based on compassion-focused thematic questions. All students completed a pre- and post-Self-Compassion Scale, Compassion Scale, and Toronto Mindfulness Scale. Students in this course were compared with students in different courses about non-clinical topics delivered at the same time. Wilcoxon Signed Rank tests and Mann Whitney U tests were used to assess potential associations between pre- and post-survey responses for the validated scales and subscales.

RESULTS

17 fourth-year medical students completed pre- and post-course tests, 11 participated in the compassion curriculum while 6 participated from the other courses. Before any of the courses began, all students performed similarly on the pre-test across all scales. The students in the compassion curriculum demonstrated a significant increase in their total Self-Compassion score by 8.7 [95% CI 4.3 to 13.2] points (p = 0.008), total Compassion score by 6.0 [95% CI 1.4 to 10.6] points (p = 0.012), and the curiosity component of the Toronto Mindfulness Scale by 4.4 [95% CI 1.0 to 7.7] points (p = 0.012). There was no statistically significant difference between pre- and post-tests among the non-compassion curriculum students in the aforementioned scales (p = 0.461, p = 0.144, p = 0.785, respectively).

CONCLUSIONS

Our results indicate that the students in our course developed an enhanced ability to engage in self-compassion, to understand the shared human experience, and to be motivated to act to alleviate suffering. Regardless of a program's existing compassion education, this customizable model allows for easy integration into a medical student's crowded curriculum. Furthermore, although teaching compassion early and often in a clinician's training is desirable, our study that targeted fourth-year medical students suggests an additional benefit of rekindling the loss of compassion well described in a medical student's clinical years.

Receiving a Prenatal or Postnatal Diagnosis of (Dis)Ability: The Role and Importance of the Nurse

ABSTRACT

The phenomenon of carrying and birthing an infant with a (dis)ability is complex and emotionally driven for parents. Infants with (dis)abilities are at risk for long-term health and developmental challenges, which may cause fear and stress in families. Parents report dissatisfaction with their experience of learning of their infant's (dis)ability diagnosis. After unexpected news is given to expecting or new parents prenatally or postnatally, it is the nurse who is often left with parents during an extremely emotional and vulnerable time. Although nurses play a pivotal role in supporting parents through this vulnerable time, their specific role is not well defined. This narrative synthesis reviews the role of the nurse during complex family situations and applies findings to their role in supporting families through receiving the diagnosis of a (dis)ability for their infant either prenatally or postnatally. Nurses can assist parents through this process of adaptation by using a compassionate and empathetic approach in their care, facilitating opportunities for parent-infant bonding, speaking with person-first language, clarifying complex information, and assisting with allocation of various internal and external resources. Future research dedicated to the creation of best practice clinical guidelines on communicating with families during the diagnosis of (dis)ability would assist nurses and other health care professionals in meeting the multifaceted and sensitive needs of parents and families, ultimately contributing to improved health outcomes for the parents, family, and infant.

Compassion Dynamics in Medical Students: An Ecological Momentary Assessment Study

Effective interventions to support compassionate patient- and self-care requires an understanding of how to best assess compassion. Micro-ecological momentary assessment (micro-EMA), a method in which participants provide brief responses in real-time within their own environments, can capture changes in compassion across time and contexts. This study examined a micro-EMA approach for measuring the temporal dynamics of compassion in medical students during the COVID-19 pandemic. Medical students (N = 47) completed demographic information and self-report questionnaires assessing empathy and compassion for self and others. Participants then completed six bursts of micro-EMA smartphone-delivered surveys. Each burst was 14 days, with 28 days between bursts. During each burst, participants received four daily micro-EMA surveys assessing compassion, stress, positive affect, and negative affect. Dynamic structural equation modeling was used to examine micro-EMA responses. The overall micro-EMA response rate was 83.75%. On average, daily compassion did not significantly change across the academic year. However, there was significant within-person variability in medical students' compassion trajectories over the training year (b = 0.027, p < .01). At concurrent timepoints, micro-EMA assessed compassion was associated with greater happiness (b = 0.142, p < .001) and lower stress (b = -0.052, p < .05) but was not associated with sadness. In lagged analyses, higher micro-EMA assessed compassion predicted higher next day happiness (b = 0.116, p < .01) and vice versa (b = 0.185, p < .01). Results suggest it is feasible to use micro-EMA to assess daily levels of compassion among medical students. Additionally, there is wide variability in day-to-day fluctuations in compassion levels among medical students, with some students showing substantial increases in daily compassion across the training year and others showing decreases. Positive affect as opposed to negative affect may have particularly strong associations with compassion. Further examination of antecedents and consequences of fluctuations in daily compassion could inform potent intervention targets.

Beyond compassion fatigue, compassion as a virtue

One of the great problems of caregivers and health professionals in recent times has been the so-called compassion fatigue and its association with burnout syndrome. Another pole of compassion has been described in terms of compassion satisfaction. Both propositions could be problematic in the caregiving setting. This is an analytical reflective article that through an apparent aporia tries to problematize and propose a theoretical synthesis that allows to denote compassion as a virtue in Aristotelian terms. To this end, it resorts to etymologies, translations and mainly to the classical theoretical references regarding compassion fatigue, compassion satisfaction and, of course, Aristotelian ethics. This is a theoretical bet that leaves open the discussion regarding the dichotomies compassion fatigue and compassion satisfaction; apathy and hyperpathy; and proposes to rethink compassion as a virtue, a reasoned middle ground, contextualized in the framework of care between two possible excesses.

Item development for a patient-reported measure of compassionate healthcare in action

BACKGROUND

Compassionate care is a fundamental component of healthcare today; yet, many measures of compassionate care are subjective in focus and lack clarity around what compassionate care looks like in practice. Measures mostly relate to physical healthcare settings, neglecting mental healthcare. They also lack significant involvement of people with lived experience (PLE) of healthcare delivery in their development. This study aimed to begin the process of developing a new patient-reported measure, one that captures the observable actions of compassionate care delivery or 'compassionate healthcare in action' by any healthcare professional working in any care setting. The study involves PLE of healthcare delivery, both patients and staff, throughout.

METHODS

A multistage mixed-methods scale development process was followed. First, items were derived inductively from reflexive thematic analysis of patient and clinician interviews about what compassionate care meant to them (n = 8), with additional items derived deductively from a literature review of existing measures. Next, a panel of patient, clinician and researcher experts in compassionate care was recruited (Round 1: n = 33, Round 2: n = 29), who refined these items in a two-round modified online Delphi process.

RESULTS

Consensus was reached on 21 items of compassionate care in action relating to six facets: understanding, communication, attention, action, emotional sensitivity and connection. These items will form the basis for further scale development.

CONCLUSIONS

This item development work has laid the foundation of a potential new tool to systematically measure what compassionate healthcare in action looks like to patients. Further research is underway to produce a valid and reliable version of this proposed new measure. We have outlined these initial stages in detail in the hope of encouraging greater transparency and replicability in measure development, as well as emphasising the value of involving PLE throughout the process.

PATIENT OR PUBLIC CONTRIBUTION

This study involved PLE of both physical and mental healthcare (as staff, patients and service users) throughout the development of the new measure, including initial project conceptualisation and participation in item generation and refinement stages.

Compassionate Presence in Seriously Ill Cancer Patients

Background: Compassion is a relational response to patients' suffering. Palliative care focuses not only on skills but also on compassion. Nevertheless, incorporated patient perspectives are largely missing from existing research. Aim: Our mixed-method exploratory study in a major Swiss cancer center sought to better understand compassionate presence, its benefits and challenges for patients and providers (ie, close relatives, close friends, and professionals-all referred to here as providers). It also investigated providers' motivation. Method: Twelve multidisciplinary, specially trained professionals interviewed 50 patients who had received compassionate presence. All patients had advanced cancer with risk of death. Providers were also interviewed. Data on the positive and burdensome effects of compassionate presence on patients and providers were gathered using a specific protocol. This also served to record patients' characteristics and providers' motivations to give compassion and whether providers felt sustained (eg, by nature). Results: The study suggests a high impact of compassionate presence with benefits on patients (50/50) and on providers (49/50). Enhanced connectedness was evident not only in the patient-provider relationship (38/50) but also, for instance, in an increased ability to love (8/50) or in an intensified solidarity (29/50). A considerable number of patients and providers experienced mental-spiritual change but also burdensome effects (eg, ambivalences). Providers showed a range of motivations. Conclusion: Compassion is not only necessary in existential crises and near death, but also happens and takes considerable effects precisely in such situations.

Compassionate care of nurses for the elderly admitted to the COVID-19 wards in teaching hospitals of southern Iran

BACKGROUND

Compassionate care is the main indicator of the quality regarding nursing care. The importance of this care in the recovery process for the elderly hospitalized for COVID-19 has been under-researched in studies. Therefore, this study aimed to determine the compassionate care level of nurses to the elderly hospitalized in the COVID-19 wards of teaching hospitals in the south of Iran.

METHODS

This descriptive-analytical study was conducted on 212 nurses working in the COVID-19 wards of teaching hospitals in the south of Iran, who were selected through census in a cross-sectional study. The data were collected using the Tehranineshat et al. nurses' compassionate care questionnaire and then the data were analyzed using descriptive and analytical statistics along with SPSS software version 22.

RESULTS

The mean score of nurses' compassionate care was 130.18 ± 9.42, which was at a high level. The highest and lowest scores were related to professional performance (43.17 ± 2.799) and empathic communication dimension (27.76 ± 2.970). No significant relationship was found between variables such as gender, marital status, education, work experience, and job position with the compassionate care score (P > 0.05).

CONCLUSION

Nurses providing care for hospitalized elderly are recommended to consider all aspects of compassionate care, especially empathic communication, in their educational planning.

The effect of the compassion levels of healthcare workers on their psychological well-being

BACKGROUND

A sense of compassion has a core importance in health service delivery. Research on the psychological impact of being compassionate on healthcare workers is limited.

OBJECTIVE

This research aims to examine the effect of compassion levels of healthcare workers on their psychological well-being.

METHODS

This was a cross-sectional and descriptive study. The population of the research consists of health personnel working throughout Ankara, the capital. The study was carried out with 414 healthcare workers. A personal information form, compassion scale and psychological well-being scale were used in the research questionnaire.

RESULTS

A positive and significant relationship was found between compassion and psychological well-being scores. It was determined that compassion positively affected psychological well-being levels. The level of compassion showed that there was a significant difference between the groups according to the variables of gender, family structure, job satisfaction and whether they would choose the same profession again. The level of psychological well-being was found to be significantly different between the groups in education, job satisfaction and making the same profession choice again.

CONCLUSION

It is a professional requirement that health professionals in patient care have a sense of compassion and reflect this feeling in their conduct. Research shows that the greater the compassion, the higher the psychological well-being. Therefore, undertaking training initiatives to make healthcare workers more compassionate can contribute to patient care and at the same time to the psychological well-being of healthcare workers.

Patient's views of empathic and compassionate healthcare interactions: A scoping review

BACKGROUND

Compassion and empathy are integral to safe and effective patient care. However, to date, most studies have focused on exploring, defining, measuring and analysing empathy and compassion from the perspective of researchers or clinicians. There has been limited attention to the perspectives of patients.

OBJECTIVE

The objective of this scoping review was to map the literature to identify patients' views of healthcare provider behaviours that exemplify empathic and compassionate interactions.

METHOD

This review used the Joanna Briggs Institute scoping review methodology. A comprehensive search of eight electronic databases was conducted with English language studies published in the last 10 years considered for inclusion.

RESULTS

Database searching resulted in 459 records for initial screening. After de-duplication and conducting a title and abstract review, 32 full-text articles were screened for eligibility. A total of 14 studies met the inclusion criteria and were critically reviewed using the Mixed Methods Appraisal Tool. The included papers profiled studies that had been conducted in clinical settings across seven countries. The healthcare encounters described in the papers were with a range of healthcare providers. Two overarching and interconnected categories of behaviours were identified as indicative of empathic/compassionate encounters: (1) communication skills such as listening, touch, body language, eye contact and positive demeanour; and (2) helping behaviours demonstrated by small acts of kindness that go beyond routine healthcare.

CONCLUSION

Given the breadth of studies describing the positive impact of empathy/compassion on people's physical and psychosocial wellbeing, the results from this review are valuable and shed new light on patients' views and experiences. The results provide a deeper understanding of healthcare provider behaviours that exemplify empathic and compassionate healthcare interactions and can be used to inform the education and training of healthcare providers from all disciplines.

Transpersonal Caritas Relationship: A new concept from the unitary caring science framework of Jean Watson

Objective

To analyze deeply the concept of the transpersonal caring relationship as the core of the theory of Caring Science proposed by Jean Watson. To present a historical evolution and to introduce the Transpersonal Caritas Relationship construct.

Methods

Methodological Study to support the central concept measured by the Watson Caritas patient instrument. We designed a focus group with four nursing scholars to develop the "Transpersonal Caritas Relationship" construct. We recount the history of the concept of the transpersonal caring relationship, then analyze this concept in terms of Watson's theory. We reviewed the concept with Dr. Jean Watson, presented her with the construct, and discussed our considerations.

Results

This article introduces a transitional adaptation of the concept of transpersonal relationship to Caritas' transpersonal relationship. Transpersonal Caritas Relationship is the foundation of evolved Caritas nursing, recognizing that mutual caring affects the universal field we all belong to Caritas' consciousness and action affect the energy field when the nurse relates with the other, making it possible to awaken the compassionate heart, which is the foundation of Evolved Caritas Nursing Universal love and in this way evolve to the Caritas consciousness that allows recognizing the other with loving kindness in the practice of careful. This is the proposed central concept measured in the caring approach using the Watson Caritas Patient.

Conclusion

This article introduces a transitional adaptation of the concept of transpersonal relationship to the Caritas transpersonal relationship, which is the foundation of Caritas Evolved Nursing.

Exploring the relationship between compassion, the practice environment, and quality of care as perceived by paediatric nurses

PURPOSE

To (1) explore associations between paediatric nurses' perceptions of their own compassion, the practice environment, and quality of care, and (2) identify factors that influence perceived quality of care.

DESIGN AND METHODS

Cross-sectional survey of paediatric nurses (n = 113) from a hospital network in Melbourne, Australia. The survey included the Compassion Scale, Practice Environment Scale of the Nurse Work Index (PES-NWI), a single quality of care item, and demographic items. Hierarchical regression was used to explore factors that predicted perceived care quality.

RESULTS

There were moderate positive correlations between perceived care quality and both compassion (rho = 0.36, p < .001) and practice environment (i.e., total PES-NWI: rho = 0.45, p < .001). There were significant differences in perceived care quality based on nurses' work area (i.e., critical care vs medical/surgical wards). The final hierarchical regression analysis included compassion (Step 2) and four of five PES-NWI subscales (Step 3), controlling for work area (Step 1). The model was statistically significant and explained 44% of variance in perceived quality; compassion and PES-NWI subscale 2 (Nursing foundations for quality of care) were statistically significant predictors.

CONCLUSIONS

Paediatric nurses' perceptions of quality were influenced by their own compassion for others and elements of the practice environment, particularly nursing foundations for care quality, which is characterised by a clear nursing philosophy and model of care, with programs and processes to support practice.

PRACTICE IMPLICATIONS

The findings offer insights into potentially modifiable individual and workplace factors that contribute to paediatric nurses' perceptions of care quality.

Exploring the impact of a compassion-oriented training program on personal care workers in a nursing home: A mixed-methods pilot study

This pilot study aimed to explore the impact of a compassion-oriented training program on Personal Care Workers (PCWs) in a nursing home. A mixed-methods approach was used, including pre- and post-questionnaire surveys to measure changes in compassion, and in-depth interviews and daily diaries to explore PCWs' perceptions and experiences. A convenience sample of five female PCWs from a nursing home in Hong Kong participated in the study. The quantitative results showed that the PCWs experienced a decline in compassion after participating in the program. The qualitative data analysis identified three themes: (1) the multifaceted nature of compassion, (2) barriers and threats to compassion, and (3) transfer of skills at the workplace. Overall, These findings highlighted the complexity of implementing effective compassion training programs in nursing home, and emphasized the importance of recognizing the multifaceted nature of compassion and addressing barriers and threats to compassion in the workplace.

Understanding the Patient's Perspective on Nursing Excellence: Insights From Patient Experience Data

This performance improvement project leverages patient experience data to better understand patient preferences and values with respect to care from nurses. Through the analysis of both quantitative and qualitative data collected in patient experience surveys, the authors explore the concept of nursing excellence from the patient's perspective and discuss practical approaches, based on the Compassionate Connected Care model, to achieve desired improvement goals for nursing.

Predictors of Medical Students' Compassion and Related Constructs: A Systematic Review

Phenomenon: Compassion, and related constructs such as empathy, are core values in healthcare, with known benefits for both patients and staff. Yet research on the factors that affect compassion and compassion-related constructs remains scattered. This review systematizes and synthesizes studies investigating the predictors of compassion and related constructs among medical students, allowing for a better understanding of the factors that both positively and negatively contribute to the development of compassionate future physicians. Approach: A systematic review of 12 databases for studies from database inception up until April 2020 was conducted. Non-peer-reviewed literature and studies in which >50% of the sample were non-medical students were excluded. Intervention studies were also out of the scope of this review. We assessed risk of bias and confidence in the findings using standardized tools. Data were categorized within the Transactional Model of Physician Compassion, a framework in which compassion is influenced by personal (student), environmental, patient/family, and clinical factors. Findings: Of 14,060 retrieved articles, 222 studies were included. Of these, 95% studied student factors, but only 25% studied environmental, 9% studied patient, and 6% studied clinical factors. Predictors of greater compassion included maturity; work and life experiences; personality traits of openness to experience and agreeableness; skills such as perspective taking, reflection, and mindfulness; and positive role modeling. Conversely, negative attitudes/emotions, burnout, stress, detachment, operating in cultures prioritizing knowledge and efficiency over humanistic care, negative role models, time constraints, and heavy workloads predicted lower compassion. Patient-related factors included "difficult" and "noncompliant" patients or those perceived as responsible for their illness. Overall, 60% of studies had a serious risk of bias, particularly confounding and participant selection biases. Insights: Medical student compassion is predicted by a wide range of factors relating to the student, their training environment, their patients, and the clinical situation. However, existing research has largely focused on student factors (e.g., sociodemographic and dispositional traits), many of which are not amenable to intervention. Skills such as perspective taking, reflection, and mindfulness are associated with higher compassion and may present opportunities for intervention. There is also strong evidence that environmental factors shape students' compassion. Researchers and educators should continue to explore the impact of patient and clinical factors on students' compassion. Studies remain at high risk of bias.

The impact of a reminder email on the return to care behavior of infertility patients after a first office visit: A quality improvement project

Research question

Prior research has determined that up to half of infertility patients attend one visit with an infertility specialist but do not return for a diagnostic workup or treatment. As part of a quality-of-care improvement project, patients who had not returned after one visit with an infertility specialist received an email which asked why they had not returned. The return to care behavior was then compared to a period of time when the email was not sent out, to answer the question as to whether or not the email had a significant impact on behavior.

Design

From July 2017 to March 2018, 301 eligible patients who attended one visit but did not return to care received an email; 657 subsequent patients from April to December 2018 did not receive one. The email asked questions about that visit, offered support, contact information for the employee sending the email and why they had not returned.

Results

All patients were followed for 11 months after their initial visit. Forty-one percent of the email group returned to care, compared to 32% who did not (P < 0.0014). For those who gave a reason why they hadn't returned, 32% of the respondents conceived on their own, 3% transferred to another infertility center, 31% were taking a break, 3% were unhappy with their care, and 31% made a return to care appointment. Thus, the email was associated with a significant increase in return to care when compared to women who did not receive an email. The most common reason why patients did not return was spontaneous conception closely followed by taking a break.

Conclusions

A compassionate email sent after one visit may increase return to care behavior.

Exploring attitudes of healthcare professionals towards those with fibromyalgia: A Q-methodological approach

Fibromyalgia remains a difficult condition to diagnose and treat. Research suggests that this leads to frustrating experiences for service users and healthcare professionals. This has led to negative healthcare professional attitudes towards working with those with fibromyalgia. The research to date reports negative attitudes and predominantly investigates attitudes of primary care physicians. This study explores the attitudes of a range of healthcare professionals towards those diagnosed with fibromyalgia. Using Q-methodology, 27 healthcare professionals completed a sorting task and questionnaire to prioritise statements relating to a range of different attitudes towards service users. All participants significantly loaded onto three factors that explained a total of 64% of the data variance. Factor 1 reflected the attitude 'Service users with fibromyalgia are no different to other service users and I enjoy working with them'. Factor 2 reflected the attitude 'Service users with fibromyalgia are inaccurate informants of their own condition due to lack of understanding of their condition and are not likely to engage in treatments'. Factor 3 reflected the attitude 'Service users with fibromyalgia are trustworthy with a lot of clinical problems [but I lack confidence in specialist skills to support them]'. Contrary to the current literature, there appears to be supportive attitudes from healthcare professionals towards service users diagnosed with fibromyalgia. Increased specialised training, clinical exposure to working with fibromyalgia and reflective practice spaces were identified as elements that could improve healthcare professional attitudes.

Kindness: Definitions and a pilot study for the development of a kindness scale in healthcare

BACKGROUND

Empathy and compassion currently receive the most attention in healthcare with respect to the medical humanities and while these skills are important for any clinician to learn, they are complex and can be daunting to healthcare trainees when first encountered. Kindness is a simple, time-sensitive behavior not yet well characterized in the healthcare setting. With this study, we aim to clearly define it as well as investigate a few common examples of kindness that might be used to create a scale for use in the healthcare setting.

METHODS

A literature search was performed to rigorously define kindness. A kindness scale based on this definition was then compiled and administered to 45 patients across three outpatient clinical settings to evaluate the association between several actions and the patient's perception of kindness.

RESULTS

Kind actions are small, take little effort, and are short in duration to their intended effect. We define kindness as an action that benefits another, as perceived by the recipient of the kind action. The results from our clinical study indicate several actions such as greeting the patient with a smile, asking questions about the patient's daily life, listening carefully, and appearing interested in the patient have a moderate strength correlation to a perception of kindness. The physician being perceived as kind also had a weak-moderate strength correlation to the patient subjectively reporting improvement after their visit.

CONCLUSIONS

Definitions in the medical humanities are important as they guide the scales used to measure them. This article defines kindness and describes some examples of its manifestation in the healthcare setting. Our study indicates that performing kind actions may improve a patient's subjective perception of their care, however, future studies are needed to evaluate whether this benefit extends to health outcomes as has been demonstrated for skills such as empathy and good communication. "Constant kindness can accomplish much. As the sun makes ice melt, kindness causes misunderstanding, mistrust, and hostility to evaporate." ~Albert Schweitzer.

Understanding the Intricacies of Delivering Compassionate Care in the Intensive Care Unit and What Hinders It: A Qualitative Study of Members of 2 Critical Care Societies

BACKGROUND

Patient-centered care is increasing in importance especially in the post-coronavirus disease 2019 (COVID-19) pandemic era. We sought to understand factors affecting compassionate care faced by intensivists in the intensive care unit (ICU).

METHODS

Using survey methodology incorporating 3 real-life case vignettes, responses were elicited to difficult ethical and moral dilemmas in the ICU setting. Members of 2 critical care societies in the United States and Europe were included in the survey.

RESULTS

Responses from 323 intensivists (32% out of 1000 members who opened the initial email invitation) around the world were analyzed thematically. Conflicts between patient choices and suggested medical care, institutional/work constraints restricting compassionate care and leading to burnout, and personal variables influencing compassionate care were the themes that emerged from our investigation. The results demonstrate that intensivists have compassion for their patients and want to provide patient-centered care, but also experience stress due to their limited ability to improve their patients' conditions.

CONCLUSIONS

Compassionate attitudes can be hindered by an underlying worry about the decision made by the patient and their family, a lack of confidence in making hard moral decisions, and the burdens of burnout.

Moral barrier to compassion: How perceived badness of sufferers dampens observers' compassionate responses

Compassion has been theorized as a desirable prosocial emotion due to its potential to transcend arbitrary boundaries (e.g., race, physical distance) and motivate us to alleviate the suffering of all human beings. Our paper nevertheless examines a potential moral barrier to compassion--whether and how moral evaluations of the suffering and the sufferer hinder our compassion and prosocial motivation. In four pre-registered studies (total N = 421, within-participant design), we demonstrated that adult U.S. participants withheld their compassion and willingness to help when they perceived moral badness of the sufferer, even when the perceived moral badness did not directly cause the suffering. The effects were found in terms of diverse types of moral judgments, including the sufferers' immoral intention (e.g., harming another; Study 1), bad moral character (e.g., being a dishonest person; Study 2), and even mere associations with groups perceived as deserving of suffering based on moral status (Studies 3-4). Deservedness judgment--how much the sufferer was viewed as deserving the suffering--mediated the effect between moral judgment and compassionate responses. Importantly, participants judged withholding compassion based on moral deservedness as what should be done and what morally good people would do, suggesting that people hold a normative view of the tendency that might make it difficult to overcome. Our findings thus reveal moral judgment as a barrier that prevents us from alleviating the suffering of all human beings.

Feasibility of a Loving Kindness Intervention for Mitigating Weight Stigma in Nursing Students: A Focus on Self-Compassion

Objectives

Preliminary research on self-compassion as a target for reducing forms of bias is promising, yet healthcare provider self-compassion has not yet been explored in relationship to weight bias. Healthcare providers commonly endorse weight stigma and bias, contributing to health disparities for patients with “obesity.” The current study explores the feasibility of the self-compassion loving kindness meditation (LKM) as a brief intervention that reduces weight bias in nursing students.

Method

Participants (189 nursing students) were randomly assigned to the LKM condition or body scan control condition before engaging in an implicit bias task and answering self-report measures of internalization of the thin ideal, weight bias, positive attitudes towards people with “obesity,” positive emotions, self-compassion, cognitive flexibility, and compassionate care.

Results

Statistically significant differences in self-compassion, cognitive flexibility, weight bias, and compassionate care failed to be found between the groups. Participants in the LKM condition endorsed significantly higher levels of positive emotionality compared to the control condition. Higher levels of self-compassion were related to lower levels of weight bias for participants in both conditions. Multiple linear regression analyses revealed that internalization of the thin ideal and self-compassion accounted for 19.2% of the variance in positive attitudes towards people with “obesity.”

Conclusions

This study suggests the importance of examining self- and other-compassion in the context of weight stigma. Its findings exemplify the complexity of weight stigma and the need to further explore the mechanisms to be targeted to effectively reduce healthcare professionals’ bias.

Pre-registration

This study is not preregistered.

Ethical sensitivity and compassion in home care: Leaders' views

BACKGROUND

With an increasing older population, the pressure on home care resources is growing, which makes it important to ensure the maintenance of quality care. It is known that compassion and ethical sensitivity can improve the quality of care, but little is known about care leaders' perceptions on ethical sensitivity and compassion in home care and how it is associated with staff competence and thus quality of care.

AIM

The aim of the study was to explore home care leaders' perceptions of ethical sensitivity and compassion associated with care quality in home care.

RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT

A hermeneutical approach with a qualitative explorative design was used. The data consists of texts from 10 in-depth interviews with home care leaders. Content analysis was used as a method.

ETHICAL CONSIDERATIONS

The study was conducted following the ethical guidelines of the Declaration of Helsinki and the Finnish Advisory Board of Research Ethics. Research ethics permission was applied for from a Research Ethics Board.

FINDINGS

One overall theme and four subthemes were found. The overall theme was: "Compassion provides deeper meaning and ethical sensitivity provides means for knowing how to act".

DISCUSSION

If nurses fail to be sensitive and compassionate with patients, good and high qualitative home care cannot be achieved. Ethical sensitivity and compassion can be seen as resources in home care but the organization and the care leaders need to provide the support for these to develop.

CONCLUSION

This study provides an understanding of the meaning of ethical sensitivity and compassion as sources of strength and their link to quality of care in a home care context. Further studies could focus on how to build compassion and ethical sensitivity into home-based care and how to ensure adequate support for healthcare professionals' compassion and ethical sensitivity.

Working in value-discrepant environments inhibits clinicians' ability to provide compassion and reduces well-being: A cross-sectional study

BACKGROUND

The practice of compassion in healthcare leads to better patient and clinician outcomes. However, compassion in healthcare is increasingly lacking, and the rates of professional burnout are high. Most research to date has focused on individual-level predictors of compassion and burnout. Little is known regarding how organizational factors might impact clinicians' ability to express compassion and well-being. The main study objective was to describe the association between personal and organizational value discrepancies and compassion ability, burnout, job satisfaction, absenteeism and consideration of early retirement among healthcare professionals.

METHODS

More than 1000 practising healthcare professionals (doctors, nurses and allied health professionals) were recruited in Aotearoa/New Zealand. The study was conducted via an online cross-sectional survey and was preregistered on AsPredicted (75407). The main outcome measures were compassionate ability and competence, burnout, job satisfaction and measures of absenteeism and consideration of early retirement.

RESULTS

Perceived discrepancies between personal and organizational values predicted lower compassion ability (B = -0.006, 95% CI [-0.01, -0.00], p < 0.001 and f ²  = 0.05) but not competence (p = 0.24), lower job satisfaction (B = -0.20, 95% CI [-0.23, -0.17], p < 0.001 and f ²  = 0.14), higher burnout (B = 0.02, 95% CI [0.01, 0.03], p < 0.001 and f ²  = 0.06), absenteeism (B = 0.004, 95% CI [0.00, 0.01], p = 0.01 and f ²  = 0.01) and greater consideration of early retirement (B = 0.02, 95% CI [0.00, 0.03], p = 0.04 and f ²  = 0.004).

CONCLUSIONS

Working in value-discrepant environments predicts a range of poorer outcomes among healthcare professionals, including hindering the ability to be compassionate. Scalable organizational and systems-level interventions that address operational processes and practices that lead to the experience of value discrepancies are recommended to improve clinician performance and well-being outcomes.

Empathy levels among health professional students at a large midwestern public university - a cross-sectional study

BACKGROUND

Empathic care is considered extremely important by patients and providers alike but there is still an ample need for assessing empathy among healthcare students and professionals and identifying appropriate educational interventions to improve it. This study aims to assess empathy levels and associated factors among students at different healthcare colleges at the University of Iowa.

METHODS

An online survey was delivered to healthcare students, including nursing, pharmacy, dental, and medical colleges (IRB ID #202,003,636). The cross-sectional survey included background questions, probing questions, college-specific questions, and the Jefferson Scale of Empathy-Health Professionals Student version (JSPE-HPS). To examine bivariate associations, Kruskal Wallis and Wilcoxon rank sum tests were used. A linear model with no transformation was used in the multivariable analysis.

RESULTS

Three hundred students responded to the survey. Overall JSPE-HPS score was 116 (± 11.7), consistent with other healthcare professional samples. There was no significant difference in JSPE-HPS score among the different colleges (P = 0.532).

CONCLUSION

Controlling for other variables in the linear model, healthcare students' view of their faculty's empathy toward patients and students' self-reported empathy levels were significantly associated with students' JSPE-HPS scores.

But what does it mean to us? Radiographic patients and carer perceptions of compassion

INTRODUCTION

An increased focus on compassion was one of the recommendations in the Francis Report following an inquiry into failures of care at the Mid Staffordshire NHS Trust in 2010. Responses to the Francis report did not take up the question of what compassion meant and how its recommendations might be meaningfully implemented in radiography practice. As part of two wider doctoral research studies, the findings presented in this paper reveal patients and carers perspectives of how compassionate care is experienced, based on an exploration of their experiences, views and attitudes in order to better understand its meaning and application in radiographic practice.

METHODS

A constructivist approach was taken with appropriate ethical approval. Using a combination of interviews, focus groups, co-production workshops and online discussion forums the authors explored the experiences and opinions of patients and carers about compassion in radiotherapy and diagnostic imaging. Data were transcribed and analysed thematically.

RESULTS

The thematically mapped findings are presented under four sub-themes: The values of caring vs the 'business' values of the NHS, Person-centred care, Characteristics of the radiographer and Compassion in the radiographer-patient interaction.

CONCLUSION

Looking at compassion through a patient's lens has highlighted how person-centred care consists of components not attributable to radiographers alone. The personal values of a radiographer must not only align with those of the profession they seek to join, but the value placed on compassion must also be reflected in the environment in which they practice. Alignment signifies patients are part of a compassionate culture.

IMPLICATIONS FOR PRACTICE

Equal emphasis should be placed on both technical and caring practices in order to stop the profession being perceived as target-driven, rather than one which ensures patients are at the heart of practice.

Provision of Compassionate and Empathic Care as a Well-Being Preservation Tool for Emergency Physicians: A Scoping Review

Objective

Compassion and physician well-being are two key components related to quality care in health including emergency medicine. The objective of this study was to explore the impact of compassion in care on the well-being of emergency physicians. We conducted a scoping review to explore the impact of provision of compassionate care by emergency physicians on their well-being and subconcepts.

Methods

Four electronic databases and grey literature were searched to find evidence related to compassion, empathy, self-compassion, and their impact on emergency physicians' well-being. Following title and abstract review, two reviewers independently screened full-text articles, and extracted data. Data were presented using descriptive statistics and a narrative analysis.

Results

A total of 803 reports were identified in databases. Three articles met eligibility criteria for data extraction. None directly examined compassion and well-being. Included studies addressed empathy and burnout in emergency medicine professionals.

Conclusion

No high-quality evidence could be found on the topic in the population of interest. Literature related to the topic of compassion in physicians, especially in emergency physicians, a field known for its high demand and stress levels, is currently scarce and additional evidence is needed to better describe and understand the association between physicians' compassion and well-being.

Artificial intelligence technologies and compassion in healthcare: A systematic scoping review

Background

Advances in artificial intelligence (AI) technologies, together with the availability of big data in society, creates uncertainties about how these developments will affect healthcare systems worldwide. Compassion is essential for high-quality healthcare and research shows how prosocial caring behaviors benefit human health and societies. However, the possible association between AI technologies and compassion is under conceptualized and underexplored.

Objectives

The aim of this scoping review is to provide a comprehensive depth and a balanced perspective of the emerging topic of AI technologies and compassion, to inform future research and practice. The review questions were: How is compassion discussed in relation to AI technologies in healthcare? How are AI technologies being used to enhance compassion in healthcare? What are the gaps in current knowledge and unexplored potential? What are the key areas where AI technologies could support compassion in healthcare?

Materials and methods

A systematic scoping review following five steps of Joanna Briggs Institute methodology. Presentation of the scoping review conforms with PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Eligibility criteria were defined according to 3 concept constructs (AI technologies, compassion, healthcare) developed from the literature and informed by medical subject headings (MeSH) and key words for the electronic searches. Sources of evidence were Web of Science and PubMed databases, articles published in English language 2011-2022. Articles were screened by title/abstract using inclusion/exclusion criteria. Data extracted (author, date of publication, type of article, aim/context of healthcare, key relevant findings, country) was charted using data tables. Thematic analysis used an inductive-deductive approach to generate code categories from the review questions and the data. A multidisciplinary team assessed themes for resonance and relevance to research and practice.

Results

Searches identified 3,124 articles. A total of 197 were included after screening. The number of articles has increased over 10 years (2011, n = 1 to 2021, n = 47 and from Jan-Aug 2022 n = 35 articles). Overarching themes related to the review questions were: (1) Developments and debates (7 themes) Concerns about AI ethics, healthcare jobs, and loss of empathy; Human-centered design of AI technologies for healthcare; Optimistic speculation AI technologies will address care gaps; Interrogation of what it means to be human and to care; Recognition of future potential for patient monitoring, virtual proximity, and access to healthcare; Calls for curricula development and healthcare professional education; Implementation of AI applications to enhance health and wellbeing of the healthcare workforce. (2) How AI technologies enhance compassion (10 themes) Empathetic awareness; Empathetic response and relational behavior; Communication skills; Health coaching; Therapeutic interventions; Moral development learning; Clinical knowledge and clinical assessment; Healthcare quality assessment; Therapeutic bond and therapeutic alliance; Providing health information and advice. (3) Gaps in knowledge (4 themes) Educational effectiveness of AI-assisted learning; Patient diversity and AI technologies; Implementation of AI technologies in education and practice settings; Safety and clinical effectiveness of AI technologies. (4) Key areas for development (3 themes) Enriching education, learning and clinical practice; Extending healing spaces; Enhancing healing relationships.

Conclusion

There is an association between AI technologies and compassion in healthcare and interest in this association has grown internationally over the last decade. In a range of healthcare contexts, AI technologies are being used to enhance empathetic awareness; empathetic response and relational behavior; communication skills; health coaching; therapeutic interventions; moral development learning; clinical knowledge and clinical assessment; healthcare quality assessment; therapeutic bond and therapeutic alliance; and to provide health information and advice. The findings inform a reconceptualization of compassion as a human-AI system of intelligent caring comprising six elements: (1) Awareness of suffering (e.g., pain, distress, risk, disadvantage); (2) Understanding the suffering (significance, context, rights, responsibilities etc.); (3) Connecting with the suffering (e.g., verbal, physical, signs and symbols); (4) Making a judgment about the suffering (the need to act); (5) Responding with an intention to alleviate the suffering; (6) Attention to the effect and outcomes of the response. These elements can operate at an individual (human or machine) and collective systems level (healthcare organizations or systems) as a cyclical system to alleviate different types of suffering. New and novel approaches to human-AI intelligent caring could enrich education, learning, and clinical practice; extend healing spaces; and enhance healing relationships.

Implications

In a complex adaptive system such as healthcare, human-AI intelligent caring will need to be implemented, not as an ideology, but through strategic choices, incentives, regulation, professional education, and training, as well as through joined up thinking about human-AI intelligent caring. Research funders can encourage research and development into the topic of AI technologies and compassion as a system of human-AI intelligent caring. Educators, technologists, and health professionals can inform themselves about the system of human-AI intelligent caring.

Program Leaders' and Educators' Perspectives on the Factors Impacting the Implementation and Sustainment of Compassion Training Programs: A Qualitative Study

PHENOMENON

Training programs have been used to improve compassion in healthcare, but the factors necessary to make such programs successful and sustainable have not been identified. This thematic analysis aimed to bridge the gap between theory and practice by drawing on the experiences of international leaders and educators of compassion training programs to develop a clear understanding of what is relevant and effective and how compassion training is implemented and sustained.

APPROACH

International leaders and educators of compassion training programs (N = 15) were identified through convenience sampling based on academic and gray literature searches. Semi-structured face-to-face interviews with these participants were conducted between June 2020 and November 2020 in order to identify facilitators, barriers, and environmental conditions influencing the implementation and maintenance of compassion training programs. The interviews were recorded, transcribed verbatim, and analyzed using thematic analysis.

FINDINGS

Six categories affecting the operationalization of compassion training programs were identified 1) origins, foundational principles and purpose, 2) curricular content, 3) methods of teaching and learning, 4) trainer qualities, 5) challenges and facilitators, and 6) evaluation and impact.

INSIGHTS

Compassion training should be rooted in the construct of interest and incorporate patients' needs and their experience of compassion, with patient-reported compassion scores integrated before and after training. Compassion training should be delivered by highly qualified educators who have an understanding of the challenges associated with integrating compassion into clinical practice, a dedicated contemplative practice, and a compassionate presence in the classroom. Prior to implementing compassion training, leadership support should be secured to create an ethos of compassion throughout the organization.

Understanding compassionate care from the patient perspective: Highlighting the experience of head and neck cancer care

Objectives

To address the knowledge gap in the practice of compassionate healthcare by elucidating patient perspectives on compassion, empathy, and sympathy.

Methods

Semi-structured telephone interviews were conducted at two time points with patients undergoing head and neck cancer treatment. Questions explored participants' understanding of compassion, sympathy, and empathy, as they relate to each other and to healthcare. Interviewers manually recorded responses. Qualitative exploratory methods were used to analyze data; inductive line-by-line coding was conducted to develop primary codes. Themes emerged through categorization of codes.

Results

Ninety-five interviews conducted with 63 participants across two time points revealed four major themes - Compassion-vs-Empathy-vs-Sympathy, Coping Methods, Showing Care, and Nature of Interaction - encompassing seven categories, with a total of 24 codes. Codes were consistent across time points, except for two new codes, "positivity" and "personalized" emerging during follow-up interviews.

Conclusions

Patient narrative from this study supported the concept that compassion is multidimensional and enabled several dimensions to be identified, highlighting the importance of patient perspectives in improving the provision of compassionate healthcare. Findings should be considered in future training and practice.

Étude des soins compatissants du point de vue du patient dans l’optique particulière des soins du cancer de la tête et du cou

Objectifs

Améliorer les connaissances sur la pratique des soins compatissants en mettant en lumière le point de vue des patients sur la compassion, l’empathie et la sympathie.

Méthodes

Des entretiens téléphoniques semi-structurés ont été menés à deux moments précis avec des patients suivant un traitement contre le cancer de la tête et du cou. Les questions visaient à explorer la compréhension qu’ont les participants de la compassion, de la sympathie, de l’empathie et des relations mutuelles entre ces notions dans un contexte de soins de santé. Les chercheurs ont consigné manuellement les réponses. Des méthodes exploratoires qualitatives ont été utilisées pour analyser les données et un codage inductif ligne par ligne a été effectué pour développer des codes primaires. Une catégorisation des codes a ensuite permis de faire ressortir des thèmes récurrents.

Résultats

Quatre-vingt-quinze entretiens menés avec 63 participants à deux moments différents ont fait ressortir quatre thèmes principaux: 1) manifestations de bienveillance; 2) nature des interactions; 3) compassion, empathie et sympathie; 4) méthodes d’adaptation. Ces thèmes se subdivisaient en sept catégories, conduisant à un total de 24 codes. Les codes étaient cohérents d’un point de vue temporel, à l’exception de deux nouveaux codes, « positivité » et « personnalisé », apparus lors des entretiens de suivi.

Conclusions

Les témoignages des patients de cette étude ont conforté le concept selon lequel la compassion est multidimensionnelle et ont permis de définir plusieurs dimensions de ce sentiment, soulignant l’importance de tenir compte du point de vue des patients pour améliorer la prestation de soins compatissants. Les conclusions devraient être intégrées dans les formations et les pratiques futures.

Drivers and drainers of compassion in intensive care medicine: An empirical study using video vignettes

BACKGROUND

The aim was to determine what factors drive and enhance compassionate care behaviors in the ICU setting and which factors drain and negate such caring attitudes and behaviors.

METHODS

Qualitative, focus group discussions using video vignettes. 20 participants agreed to be part of 3 separate focus groups facilitated by the authors.

RESULTS

Thematic analysis revealed emphasis on behavior and nonverbal cues, clinical decision making, communication and sensitivity, and building humane relations. The results show that physicians feel driven by the humanity and sensitivity felt in ICU work, however, there exists structural incompetence, as well as the stress and personal -systemic imbalances of ICU work, which leads to burnout and erosion of such motivations, draining compassion.

CONCLUSIONS

Regulatory and scheduling practices must be examined to foster the growth of compassionate behaviors and attitudes in healthcare, and these should be treated as essential patient centered metrics.

Development and psychometric testing of a scale measuring caring behaviors for healthcare students and providers

This study intended to develop and assess the psychometric properties of a caring behavior scale on healthcare students and providers (CBS-HSP) in a Taiwanese population. After a literature review was conducted and an expert panel was consulted for item generation, 104 items for the CBS-HSP scale were derived on a nine-point Likert scale, with 9 indicating 'extremely important' and 1 indicating 'extremely unimportant.' A pilot study was then conducted with seven hundred forty-eight healthcare students and providers in Taiwan for further data analysis. The statistic software used in the study was SPSS for the exploratory factor analysis (EFA) and AMOS for the confirmatory factor analysis (CFA). Also, to examine the psychometric properties of the scale, internal consistency, convergent validities, discriminant validities, and model fit indices were calculated in the study. The EFA results derived 31 items in four factors, with 65.742% of the total variance explained: 'support and attentiveness' (11 items; 48.714% of the variance explained), 'professional knowledge and skills' (8 items; 8.226% of the variance explained), 'gratifying needs and responsiveness' (7 items; 5.236% of the variance explained), and 'confidentiality and trust' (5 items; 3.566% of the variance explained). The Cronbach's alphas for the four subscales and the overall scale ranged from 0.894 to 0.964. The CFA results yielded the same 31 items, with the same four factors. The CFA results demonstrated good to excellent model fit in the χ2/df ratio (1.242), GFI (0.988), CFI (0.988), TFI (0.985), and RMSEA (0.031). The Cronbach's alphas ranged between 0.866 and 0.971; the composite alphas ranged between 0.854 and 0.964. The convergent and discriminant validities also proved the stability of the CBS-HSP scale. The research results indicated that the developed CBS-HSP appeared to be a reliable instrument to measure healthcare students' and providers' caring behaviors.